| Objective: To evaluate the value of IMR in evaluating the prognosis of patients with acute anterior wall ST-segment elevation myocardial infarction undergoing emergency coronary intervention,and to analyze the influencing factors.Methods: According to certain inclusion criteria and exclusion criteria,Inpatients admitted to the Department of Cardiology,Jiangsu Subei People’s Hospital from April2015 to January 2018,all of whom were patients with acute anterior wall STEMI.A total of 50 patients(44 males and 6 females)underwent emergency PCI for all patients admitted to the hospital.IMR was measured immediately after PCI.The mean IMR was 39.28±16.8,and grouped according to the IMR values measured after PCI.The patient was diagnosed with microcirculatory disorder by IMR=40,and IMR<40U was defined as the microcirculation normal group,is group A(n=28);IMR value≥40U was defined as the microcirculation abnormal group,is group B(n=22).The general data,laboratory-related examinations,and intraoperative medications between the two groups were compared.The left ventricular function recovery was evaluated by collecting LVEF and LVEDD at 24 hours,6 months,and 12 months after surgery.The incidence of major adverse cardiac events during the 12-month follow-up period was recorded.Results: Patients in groups A and B were included in the age,neutrophil count and lymphocyte count ratio(NLR),Symptoms to balloon opening time(STB),and creatine kinase isoenzyme(CK-MB)peak.The difference was statistically significant(P<0.05);the two groups were confirmed by binary logistic regression: STB is an independent risk factor for microcirculatory disturbance in patients with acute anterior wall STEMI.The accuracy of the regression model prediction was 82%,and thedifference between the STB and the ROC curve AUC of 0.856(95% CI 0.728-0.939,P< 0.001)was statistically significant.Among them,the Cut-Off value of STB is260 min,the sensitivity is 95.45%,and the specificity is 71.43%.2.In the B group,the LVEF value at 6 months after PCI was significantly higher than that at 24 hours after PCI(49.41±10.477 vs.43.59±6.284),and the LVEF value was significantly increased(P=0.003,<0.05).Compared with the LVEF value at 12months(49.41±10.477 vs.42.05±8.677),the LVEF value was significantly decreased(P<0.001).The B group showed a significant increase in LVEDD values at 24 hours,6months,and 12 months after PCI(51.09±4.79 vs.51.14±5.83 vs.53.77±5.31),and the difference was statistically significant(P<0.05).There was no significant difference in the LVEDD values between the 6 months after PCI and the 24 hours after surgery(P=0.949,>0.05).The LVEF values of the A group at 24 hours,6 months,and 12 months after PCI(50.79±7.198 vs.55±6.837 vs.56.32±6.7)showed a significant upward trend(P < 0.001);There was no significant difference in LVEF between the 6months and 12 months after PCI(P>0.05).The LVEDD value at 12 months after PCI was significantly higher than that at 6 months after PCI(49.61±4.18 vs.47.43±3.75),and the difference was statistically significant(P<0.05).The LVEDD value at 12 months after PCI was compared with 24 hours after PCI(49.61±4.18 vs.47.46±4.17),and the LVEDD value was also significantly increased,and the difference was still statistically significant(P<0.05).There was no significant difference in the LVEDD between the 24 hours after PCI and the 6 months after PCI(P>0.05).The comparison between groups showed that the LVEF value of the A group was significantly higher than that of the B group(50.79±7.198 vs.43.59±6.284)at 24 hours after PCI(P=0.001,<0,05).At 6 months after PCI,the LVEF values in the A group were significantly higher than those in the B group(55.00±6.837 vs.49.41±10.477)(P=0.027,<0.05);at12 months after PCI,two The difference between the groups was(56.32±6.7 vs.42.05±8.677),which was still significant(P<0.001).At 24 hours after PCI,there was a statistically significant difference between the A group and the B group(47.46±4.17 vs.51.09±4.79)(P=0.006,<0.05).At 6 months after PCI,there was a statisticallysignificant difference between the A group and the B group(47.43±3.75 vs.51.14±5.83)(P=0.009,<0.05).At 12 months after PCI,the difference between the two groups(49.61±4.18 vs.53.77±5.31)was still significant(P=0.003,<0.05).The results of this study showed that the LVEF values of patients in the A group were larger than those in the B group with the prolongation of follow-up time,while the LVEDD values of the patients in the A group were smaller than those in the B group with the prolonged follow-up time.Therefore,it can be suggested that the left ventricular remodeling is lighter in the A group,and the cardiac function recovery is relatively good.The IMR measured immediately after PCI can be used as a microcirculation index to predict the long-term left ventricular function in STEMI patients.3.All patients were found to have no cardiac death,malignant arrhythmia,and target vessel disease reconstruction during 12-months follow-up period.Of the 50 patients,9 had severe heart failure re-hospitalization.There were 8 patients in the B group,and the difference between the two groups was significant(P=0.009,<0.05).Conclusion:1.IMR is a specific indicator for the diagnosis of coronary microcirculatory disorders.Multiple factors are associated with IMR.Symptoms to balloon opening time is an independent risk factor for microcirculatory disorders in patients with acute anterior wall STEMI.2.Models constructed using age,CK-MB peak,NLR,and STB can accurately predict the risk of microcirculatory disorders in patients with acute anterior wall STEMI.3.Microcirculation resistance index can predict left ventricular remodeling,left ventricular function recovery and major cardiac adverse events after PCI in patients with acute anterior wall STEMI. |
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